Provider Demographics
NPI:1427797653
Name:SEYOM-TESFA, LEAH I
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:SEYOM-TESFA
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BALD CYPRESS CIR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-8413
Mailing Address - Country:US
Mailing Address - Phone:214-533-0933
Mailing Address - Fax:
Practice Address - Street 1:3333 NAAMAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-8717
Practice Address - Country:US
Practice Address - Phone:469-367-4755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-04
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX541493163WC0400X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management